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Combined α/β‐blockade versus β 1 ‐selective blockade in essential hypertension in black and white patients
Author(s) -
Townsend Raymond R,
DiPette Donald J,
Goodman Robert,
Blumfield David,
Cronin Robert,
Gradman Alan,
Katz Lois Anne,
McCarthy E Paul,
Sopko George
Publication year - 1990
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1038/clpt.1990.210
Subject(s) - labetalol , atenolol , blood pressure , supine position , medicine , placebo , essential hypertension , diastole , anesthesia , blockade , cardiology , alternative medicine , pathology , receptor
The purpose of this multicenter investigation was to determine the efficacy and safety of the α/β‐blocker labetalol versus the β 1 ‐selective β‐blocker atenolol in white and black patients with essential hypertension. Equal numbers of black and white patients were enlisted to form four treatment groups (white patients taking either labetalol or atenolol and black patients taking either labetalol or atenolol). Two hundred ninety‐two patients (152 white and 140 black patients) with essential hypertension characterized by a standing diastolic blood pressure of 105 to 119 mm Hg (inclusive) were recruited for this trial. Patients were randomized to either labetalol (dosage titrated from 200 to 1600 mg/day) or atenolol (dosage titrated from 50 to 100 mg/day). The therapeutic goal was achievement of a standing diastolic blood pressure of 90 mm Hg or less or a fall of 15 mm Hg in diastolic pressure from baseline value at the end of the placebo run in period. At the end of the study there were no significant differences in blood pressure or heart rate changes in the supine position between the labetalol and atenolol groups. In contrast, labetalol produced greater reduction in both the standing systolic and diastolic blood pressure (−12/ −13 mm Hg, respectively) compared with atenolol (−7/ −9 mm Hg; p < 0.05; p < 0.005, respectively). The greatest decrease in blood pressure was observed in white patients receiving labetalol. In black patients the decrease in blood pressure was greater in those treated with labetalol compared with atenolol, particularly with respect to the systolic blood pressure. We conclude that the α 1 ‐blocking property of labetalol provides an additional lowering of the blood pressure over that seen with β 1 ‐blockade alone, especially in the standing position, and this enhanced efficacy is not confined to one radical group. Clinical Pharmacology and Therapeutics (1990) 48 , 665–675; doi: 10.1038/clpt.1990.210